Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study

Background

Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias.

Objectives

This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias.

Methods

This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities.

Results

Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99).

Discussion

The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias.

Conclusions

Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.

Beyond Vision: A View from Eye to Alzheimer's Disease and Dementia

With the aging of the global population, the health care burden of Alzheimer's disease (AD) and dementia is considered to increase dramatically in the coming decades. Given the insufficiency of effective interventions for AD and dementia, clinical research on identifying potentially modifiable risk factors and early diagnostic biomarkers becomes a public health priority. Currently, extracerebral manifestations with a large proportion of ocular involvement are usually recognized to precede the symptoms of AD and dementia. Growing epidemiologic evidence also suggests that eye disorders, such as cataracts, age-related macular degeneration, glaucoma, diabetic retinopathy, and so on, are closely associated with and even have a higher incidence of AD and dementia. The eye, as an extension of the central nervous system, therefore has the potential to provide a feasible approach to detecting structural and functional abnormalities of the brain. Numerous new imaging modalities are developed and give novel insights into the detection of several neurodegenerative, vascular, neuropathological, and other ocular abnormalities of AD and dementia in scientific research and clinical application. This review provides an overview of the epidemiologic associations between eye disorders and AD or dementia and summarizes the recent advances in ocular examinations and techniques employed for the detection of AD and dementia. With more brain-and-eye interconnections being identified, the eye is becoming a noninvasive and easily accessible window for the early diagnosis and prevention of AD and dementia.

Racial and ethnic disparities in the enrolment of medicare medication therapy management programs

Objectives

Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data.

Methods

Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017.

Key Findings

Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81).

Conclusions

Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.

Cost-Effectiveness of Medication Therapy Management Program Across Racial and Ethnic Groups Among Medicare Beneficiaries

OBJECTIVES

Equity and effectiveness of the medication therapy management (MTM) program in Medicare has been a policy focus since its inception. The objective of this study was to evaluate the cost-effectiveness of the Medicare MTM program in improving medication utilization quality across racial and ethnic groups.

METHODS

This study analyzed 2017 Medicare data linked to the Area Health Recourses File. A propensity score was used to match MTM enrollees and nonenrollees, and an incremental cost-effectiveness ratio between the 2 groups was calculated. Effectiveness was measured as the proportion of appropriate medication utilization based on medication utilization measures developed by Pharmacy Quality Alliance. Net monetary benefits were compared across racial and ethnic groups at various societal willingness-to-pay (WTP) thresholds. The 95% confidence intervals were obtained by nonparametric bootstrapping.

RESULTS

MTM dominated non-MTM among the total sample (N = 699 992), as MTM enrollees had lower healthcare costs ($31 135.89 vs $32 696.69) and higher proportions of appropriate medication utilization (87.47% vs 85.31%) than nonenrollees. MTM enrollees had both lower medication costs ($10 681.21 vs $11 003.08) and medical costs ($20 454.68 vs $21 693.61) compared with nonenrollees. The cost-effectiveness of MTM was higher among Black patients than White patients across the WTP thresholds. For instance, at a WTP of $3006 per percentage point increase in effectiveness, the net monetary benefit for Black patients was greater than White patients by $2334.57 (95% confidence interval $1606.53-$3028.85).

CONCLUSIONS

MTM is cost-effective in improving medication utilization quality among Medicare beneficiaries and can potentially reduce disparities between Black and White patients. Expansion of the current MTM program could maximize these benefits.

The choice of spectral similarity algorithms influences suspected soil sample provenance

Similarity algorithms are commonly used in soil forensic applications to help identify similar samples from an existing reference library as possible source locations of unknown target samples. These algorithms are well-suited to compare soil spectra. However, different similarity algorithms may lead to different clusters of similar samples, and thus different strengths of evidence in forensic investigations. To quantify this, we conducted a study to evaluate the influence of seven similarity algorithms on soil provenance, using as a sample set a soil spectral library consisting of 280 soil profiles from Anhui Province, China. This library includes three spatial scales of datasets: provincial (DS_p), county (DS_c) and field (DS_f). A set of ten samples covering a wide range of spectra variations were selected from the DS_f dataset as the "unknown" samples, with the remaining being used as the reference samples. This study aimed to: (1) evaluate how several commonly-used similarity algorithms, namely Euclidean distance (ED), Mahalanobis distance (MD), Spectral angle mapper (SAM), and Spectral information divergence (SID), as well as variants of several of these measured in standardized principal component space computed from the spectra (ED_PCA, MD_PCA and SAM_PCA), influence the identification of the matched similar samples; (2) determine the overlap in sample selection between different similarity algorithms; (3) propose best practices for similarity algorithms applied to soil forensic analysis using spectroscopy. The use of different similarity algorithms did influence the selection of most similar samples. The similarity algorithms calculated in PC space (ED_PCA, MD_PCA and SAM_PCA) performed slightly better than their counterparts calculated in spectral space. Due to the availability of a detailed spectral library, regardless of the different similarity algorithms used, the matched most similar samples were all located close to the unknowns, mostly within 3 km, with one exception. That is, the varied choices of different similarity algorithms hardly influenced the conclusion of soil provenance in this case. In general, MD_PCA, SAM and ED were the best similarity algorithms overall. However, since there was no single best algorithms for all cases, we recommend the joint use of MD_PCA, SAM and ED as an ensemble. Indications of possible sample provenance from these similarity measured can be useful evidence to complement evidence from other methods in a forensic investigation.

The efficacy and safety of pulsed-field ablation in para-Hisian paroxysmal supraventricular tachycardia: first-in-human pilot trial

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Key Research and Development Program of China

Background

Para-Hisian paroxysmal supraventricular tachycardia (PSVT) is associated with a higher risk of atrioventricular block due to proximity of the His bundle during catheter ablation. Pulsed-field ablation (PFA) with high tissue selectivity may be a promising technique for catheter ablation in patients with para-Hisian PSVT.

Purpose

This study aimed to evaluate the efficacy and safety of PFA for para-Hisian PSVT.

Methods

This investigator-initiated, single-center, single-arm, prospective study was the first in-human pilot phase to evaluate the efficacy and safety of a novel PFA system in patients with PSVT. Patients diagnosed with para-Hisian PSVT via electrophysiological examination were included and treated with PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcome was ablation success and safety after 3 months.

Results

A total of seven patients with a mean age of 49.4±13.1 years were included and underwent PFA. Acute ablation success was achieved in all seven patients. The skin-to-skin procedure time was 135.0±17.7 minutes, fluoroscopy time was 4.3±1.6 minutes, and the number of PFA applications was 7±1.6. No adverse events occurred in any patient during the ablation or during the 3-month follow-up.

Conclusion

PFA had favorable efficacy and safety in para-Hisian PSVT patients and can help minimize the risk of inadvertent atrioventricular block during ablation. PFA may be a favorable treatment choice for patients with para-Hisian PSVT.

Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias

OBJECTIVE

Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD).

METHODS

Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017.

RESULTS

In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD.

CONCLUSIONS

Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.

Predicting survival and immune microenvironment in colorectal cancer: a STAT signaling-related signature

BACKGROUND

Despite research advances, studies on predictive models of colorectal cancer (CRC) remain scarce and none have evaluated signal transducer and activator of transcription (STAT) signaling.

AIM

To develop an effective prognostic signature for and evaluate its association with immune microenvironment.

DESIGN

Comprehensive analysis based on The Cancer Genome Atlas and Gene Expression Omnibus databases with experimental validation.

METHODS

Gene expression and clinical profiles of CRC patients were extracted from the databases. Differentially expressed genes with prognostic values were used to construct a signature. Immune cell infiltration and composition were further evaluated by TIMER, single-sample gene set enrichment and CIBERSORT analyses. The impact of the hub gene Caveolin-1 (CAV1) on cell proliferation, apoptosis, senescence and tumor angiogenesis was experimentally validated.

RESULTS

The five-gene-based STAT signaling-related prognostic signature was significantly associated with CRC survival, and the nomogram was with improved prognostic efficacy than the conventional TNM stage. The STAT signaling-related signature was correlated with tumor immune microenvironment. CAV1 was further identified as the hub gene within the signature. CAV1 inhibits the proliferation and induces the apoptosis as well as senescence of CRC cells. In addition, the tumor angiogenesis of CRC can be suppressed by CAV1 overexpression.

CONCLUSIONS

The STAT signaling-related signature effectively predicts the prognosis and regulates tumor immune microenvironment in CRC. Our study underscores the role of STAT regulator, CAV1, as an important tumor suppressor in CRC carcinogenesis. Modulating STAT and its regulators could be a promising strategy for CRC in clinical practice.

[Clinical analysis of chronic eosinophilic pneumonia in 9 cases]

Objective: To investigate the clinical features, treatment and prognosis of chronic eosinophilic pneumonia. Methods: Nine patients with chronic eosinophilic pneumonia diagnosed in Shandong Provincial Qianfoshan Hospital from January 2014 to December 2020 were enrolled and followed up. The data of clinically proven chronic eosinophilic pneumonia were reviewed. Results: The 9 cases included one male and eight females, aged from 16 to 71 years (median 47 years). Among them, 5 cases were complicated with asthma, 1 case was complicated with allergic rhinitis, and 1 case had an allergic history of pollen. All the patients had cough, expectoration, chest tightness and wheezing, and a few had fatigue (3/9), fever (1/9) and chest pain (1/9). Single or multiple patchy high-density shadows (9/9), mediastinal lymphadenopathy (7/9), air bronchogram (2/9), and reticular shadow (1/9) were observed in chest CT. Peripheral eosinophils (EOS) and serum total IgE increased to varying degrees in the 9 patients. Meanwhile, the bronchoscopy of 5 cases showed elevated percentage of eosinophils in alveolar lavage fluid, and the lung biopsy of remaining 4 cases showed EOS infiltration in lung alveolar and interstitium. After receiving glucocorticoid therapy for 0.5 to 1 month, the clinical symptoms of all 9 patients had been improved and lung lesions on CT scans had been obviously absorbed. Four cases relapsed during follow-up. Conclusions: For patients especially women who have a history of allergy, elevated blood eosinophils and serum total IgE with pulmonary high-density shadow or consolidation, chronic eosinophilic pneumonia should be considered, and bronchoscopy or percutaneous lung biopsy is indicated for a definite diagnosis. Glucocorticoid therapy is effective, but the rate of recurrence is high.

Forensic soil source identification: comparing matching by color, vis-NIR spectroscopy and easily-measured physio-chemical properties

This study evaluates to what degree soil samples associated in characteristic space are also close in geographical space, i.e., the possible location from which an unknown sample was obtained in a forensic investigation. The study compares similarity computed from Munsell colors, RGB colors, and full visible-near infrared (vis-NIR) spectra by the spectral angle mapper with similarity based on six easily-measured physio-chemical properties. The reference area is Anhui Province, China with three scales of datasets: provincial, county, and field. Ten diverse "unknown" samples were selected by the Kennard-Stone algorithm from the field-scale dataset and their matches in characteristic space from the several datasets were found by the different methods. The geographic distances of the matches to the "unknowns" were used to evaluate the source identification ability. When a detailed library with local samples is present, a limited set of physio-chemical properties achieved higher geographic accuracy than the color and spectral methods. However, with a regional library the spectral and color methods are superior. Distances in RGB space reveal finer differences than exact matching in Munsell space, but whole-spectra matching outperforms both, because of the rich information influenced by more soil properties than influencing color. We recommend the use of soil vis-NIR spectra as a priority indicator for forensic soil analysis because of its success in this study and its ability to work non-destructively on small quantities of soil.

miR-143-3p inhibits proliferation and invasion of hepatocellular carcinoma cells by regulating its target gene FGF1

PURPOSE

To explore FGF1 and miR-143-3p expression in hepatocellular carcinoma (HCC) cells and its related mechanisms.

METHODS

Eighty-two HCC patients treated at our hospital from January 2018 to January 2019 were enrolled as Group A, while further 80 healthy people undergoing physical examinations during the same time period were enrolled as Group B. HCC cells and normal human liver cells were purchased, with HepG2 and SMMC-7721 cells transfected with pcDNA3.1-FGF1, si-FGF1, NC, miR-143-3p-inhibitor and miR-143-3p-mimics. FGF1 and miR-143-3p expression was detected by qRT-PCR. The expression of N-cadherin, vimentin, Snail, Slug, E-cadherin and γ-catenin was detected by Western Blotting (WB). Cell proliferation was detected by MTT assay. Cell invasion was detected by Transwell. Cell apoptosis was detected by flow cytometry (FCM).

RESULTS

FGF1 was highly expressed but miR-143-3p was poorly expressed in HCC cells. Areas under the curves (AUCs) of the two indicators were > 0.8. The indicators were correlated with the age, gender, tumor invasion, degree of differentiation, tumor location and TNM staging of the patients. Silencing FGF1 and overexpressing miR-143-3p could promote cell apoptosis, inhibit cell growth, cell epithelial-mesenchymal transition (EMT) and the expression of N-cadherin, vimentin, Snail and Slug, and increase the expression of E-cadherin and γ-catenin. Dual luciferase reporter gene assay (DLRGA) confirmed that FGF1 and miR-143-3p had a targeted relationship. The rescue experiment showed that the proliferation, invasion and apoptosis of HepG2 and SMMC-7721 cells in the miR-143-3p-mimics+pcDNA3.1-FGF1 and miR-143-3p-inhibitor+Si-FGF1 groups were not different from those in the miR-NC group.

CONCLUSION

Inhibiting FGF1 can upregulate miR-143-3p-mediated Hedgehog signaling pathway, and affect cells' EMT, proliferation and invasion, so FGF1 is expected to become a potential therapeutic target for HCC.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

CT metal artifact reduction algorithms: Toward a framework for objective performance assessment

Purpose

Although several metal artifact reduction (MAR) algorithms for computed tomography (CT) scanning are commercially available, no quantitative, rigorous, and reproducible method exists for assessing their performance. The lack of assessment methods poses a challenge to regulators, consumers, and industry. We explored a phantom‐based framework for assessing an important aspect of MAR performance: how applying MAR in the presence of metal affects model observer performance at a low‐contrast detectability (LCD) task This work is, to our knowledge, the first model observer–based framework for the evaluation of MAR algorithms in the published literature.

Methods

We designed a numerical head phantom with metal implants. In order to incorporate an element of randomness, the phantom included a rotatable inset with an inhomogeneous background. We generated simulated projection data for the phantom. We applied two variants of a simple MAR algorithm, sinogram inpainting, to the projection data, that we reconstructed using filtered backprojection. To assess how MAR affected observer performance, we examined the detectability of a signal at the center of a region of interest (ROI) by a channelized Hotelling observer (CHO). As a figure of merit, we used the area under the ROC curve (AUC).

Results

We used simulation to test our framework on two variants of the MAR technique of sinogram inpainting. We found that our method was able to resolve the difference in two different MAR algorithms’ effect on LCD task performance, as well as the difference in task performances when MAR was applied, vs not.

Conclusion

We laid out a phantom‐based framework for objective assessment of how MAR impacts low‐contrast detectability, that we tested on two MAR algorithms. Our results demonstrate the importance of testing MAR performance over a range of object and imaging parameters, since applying MAR does not always improve the quality of an image for a given diagnostic task. Our framework is an initial step toward developing a more comprehensive objective assessment method for MAR, which would require developing additional phantoms and methods specific to various clinical applications of MAR, and increasing study efficiency.

Possible scenario of forming a catalyst layer for proton exchange membrane fuel cells

Ionomer in the catalyst layer provides an ion transport channel which is essential for many electrochemical devices. As the ionomer and electrochemical catalyst are packed together in the catalyst layer, it is difficult to have a clear image of the ionomer distribution in the catalyst layer and how the ionomer is in contact with Pt or carbon. A highly dispersed catalyst was deposited on the TEM SiN grid directly using the same (ultrasonic spray) or a similar way as the catalyst was deposited on the membrane. By analyzing the distribution of various elements (C, F, S, Pt etc.), we found that the ionomer may coexist in the catalyst layer in three ways: ionomer covered Pt particles due to the relatively strong interaction between Pt and the ionomer; ionomer covered C particles; packed free ionomer in between the aggregated catalyst particles. The results show that the ionomer is prone to covering the surface of Pt particles as further evidenced by the accelerated degradation test (ADT).

Ionomer in the catalyst layer provides an ion transport channel which is essential for many electrochemical devices.

Relationship between Hashimoto's thyroiditis and papillary thyroid carcinoma in children and adolescents

OBJECTIVE

We investigated the relationship between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) in children and adolescents.

PATIENTS AND METHODS

We carried out a retrospective study of thyroidectomies performed from 2004 to 2017 at The First People's Hospital and the Tumor Hospital of Yunnan Province (Kunming, China). The occurrence and features of PTC and benign thyroid disease (BTD) in children and adolescents (age ≤ 20 years) were compared.

RESULTS

We evaluated 258 consecutive thyroidectomies. Among children and adolescents with PTC, 23 cases were histopathologically confirmed as HT. Mean tumor diameter was smaller in children and adolescents with PTC than in those with BTD. Thyroid-stimulating hormone (TSH) level was abnormally elevated in a greater proportion of children and adolescents with PTC as compared to those with BTD or youths with PTC. The proportion of thyroglobulin antibody (TGAb)- and thyroid peroxidase antibody (TpoAb)-positive children and adolescents was higher in the PTC than in the BTD group. Among children and adolescents with PTC, 23 had HT as compared to two in the BTD group. The proportion of children/adolescents with abnormally elevated TSH levels was higher for the PTC combined with HT group than for the PTC without HT group. A multivariate conditional logistic regression analysis showed that elevated TGAb was an independent risk factor for PTC in children and adolescents.

CONCLUSIONS

HT is associated with an increased occurrence of PTC in children and adolescents.

[Experience of revision cochlear implantation]

Objective:To analyse the characteristics of the revision cochlear implantation （RCI）patients，the cause of the cochlear malfunction，and the choice of RCI operative approach. Method:A total of 39 patients with RCI were enrolled in this study. The cochlear use time, cause of failure and reoperation procedure are recorded and analyzed retrospectively. Result:There were 39 patients accepted cochlear reoperation，the ages ranges from 1 to 28，average age was 7.8 years, median age was 5 years old. The cochlear use time ranges from 1 month to 7 years，average was 2.2 years, median time was 1 year. Thirty-seven patients underwent RCI,30 cases right side and 7 cases left side. The reason of RCI contains device failure (28 cases)，infection (5 cases)，incorrect electrode implantation (3 cases)，facial nerve stimulation (2 cases)，and electrode prolapse (1 case).The choice of RCI procedure was dependent on the first operation procedure,contains facial nerve recess approach (35 cases) and mastoid approach (2 cases).Contralateral implantation was performed in 5 cases, the rest were ipsilateral. Conclusion:RCI has a variety causes and the common reason is trauma and device failure，the RCI should be completed as early as possible to avoid the ossified cochlear and hearing or speech stagnation，the electrode implantation through previous approach is the best method.

In vitro and in vivo studies of the ALS-FTLD protein CHCHD10 reveal novel mitochondrial topology and protein interactions

Mutations in coiled-coil-helix-coiled-coil-helix-domain containing 10 (CHCHD10), a mitochondrial twin CX9C protein whose function is still unknown, cause myopathy, motor neuron disease, frontotemporal dementia, and Parkinson's disease. Here, we investigate CHCHD10 topology and its protein interactome, as well as the effects of CHCHD10 depletion or expression of disease-associated mutations in wild-type cells. We find that CHCHD10 associates with membranes in the mitochondrial intermembrane space, where it interacts with a closely related protein, CHCHD2. Furthermore, both CHCHD10 and CHCHD2 interact with p32/GC1QR, a protein with various intra and extra-mitochondrial functions. CHCHD10 and CHCHD2 have short half-lives, suggesting regulatory rather than structural functions. Cell lines with CHCHD10 knockdown do not display bioenergetic defects, but, unexpectedly, accumulate excessive intramitochondrial iron. In mice, CHCHD10 is expressed in many tissues, most abundantly in heart, skeletal muscle, liver, and in specific CNS regions, notably the dopaminergic neurons of the substantia nigra and spinal cord neurons, which is consistent with the pathology associated with CHCHD10 mutations. Homozygote CHCHD10 knockout mice are viable, have no gross phenotypes, no bioenergetic defects or ultrastructural mitochondrial abnormalities in brain, heart or skeletal muscle, indicating that functional redundancy or compensatory mechanisms for CHCHD10 loss occur in vivo. Instead, cells expressing S59L or R15L mutant versions of CHCHD10, but not WT, have impaired mitochondrial energy metabolism. Taken together, the evidence obtained from our in vitro and in vivo studies suggest that CHCHD10 mutants cause disease through a gain of toxic function mechanism, rather than a loss of function.

[Risk factors for long-term result of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm]

Objective: To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm(AIPA), and to analysis clinical predictors of long term major adverse clinical events(MACE). Methods: Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was (39.3±11.4) years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE. Results: Among the 29 cases, 22 cases with bechet's disease, 4 cases with Takayasu's arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair (EVAR), 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was found during follow-up. There were 3 deaths during follow-up, with 1 aneurysm related death, the rest died due to other reasons. Single factors logical regressions analysis showed discontinuing immune medicine therapy and age no less than 40 years significantly related long-term MACE(P<0.05). Meanwhile, type of original auto-immune disease, none classical EVAR were not significant related to MACE. Conclusions: Endovascular therapy is safe and effective for AIPA. Regular peri-operation and long-term immunotherapy is key to success.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

The effect of soy or isoflavones on homocysteine levels: a meta-analysis of randomised controlled trials

BACKGROUND

The present study aimed to evaluate the effect of soy or isoflavones on blood homocysteine levels via a systematic review and meta-analysis.

METHODS

Pubmed, Embase, Web of Science and the Cochrane Library (up to 16 December 2015) were used for the literature review. Only randomised controlled trials were included. The primary outcome was the standard mean difference (SMD) of blood homocysteine levels between the experimental and control groups.

RESULTS

Nineteen randomised controlled studies were included for qualitative analysis. Eighteen studies were included in the data synthesis. Soy or isoflavones were found to have no effect on homocysteine levels, with a SMD of -0.21 (95% confidence interval = -0.43 to 0.00, I² =67.7%, random effect model). No publication bias was found among those studies (P = 0.296 for Egger's test, and P = 0.198 for Begg's test).

CONCLUSIONS

Soy or isoflavones were not found to be associated with a reduction in homocysteine levels. Further studies might still be needed in carefully selected populations.

[Manganese enhanced magnetic resonance imaging investigation in the central auditory pathway of the cat]

OBJECTIVE

To compare enhancement of the central auditory pathway in cats receiving auditory stimulation between manganese enhanced magnetic resonance imaging (MEMRI) with intraperitoneal manganese injection route and MEMRI with intratympanic manganese injection route, and investigate the optimal method for displaying enhancement of the central auditory pathway.

METHODS

Twenty-seven normal hearing adult cats were randomly divided into three groups, receiving intraperitoneal manganese injection, left intratympanic manganese injection or left intratympanic gadolinium injection respectively.All cats received white noise stimulation of 80 dB in twenty-four hours after injection.Three dimensionally coronal T1-weighted imaging of the cat brain was obtained with an animal dedicated MRI scanner.The signal noise ratios (SNRs) of bilateral cochlear nuclei (CN), dorsal nuclei of the trapezoid bodies (DNTB), caudal colliculi (CC) and auditory cortices (AC) were measured on reconstructed images and compared.

RESULTS

Obvious increased SNRs on both sides were shown in intraperitoneal mangasese injection group while left predilection was shown in intratympanic manganese injection group: left CN 45.7±6.0, 37.4±11.9, 23.9±2.7, F=17.694, P=0.000; left DNTB 50.5±11.2, 37.1±11.2, 27.6±7.3, F=11.781, P=0.000; left CC 37.6±3.9, 22.6±3.1, 17.9±0.7, F=111.898, P=0.000; left AC 27.7±2.5, 17.3±2.3, 14.5±1.0, F=105.132, P=0.000; right CN 42.7±8.3, 23.9±3.0, 22.7±2.1, F=41.492, P=0.000; right DNTB 44.1±8.3, 21.9±3.0, 23.9±4.0, F=27.862, P=0.000; right CC 38.0±4.0, 21.9±3.0, 17.6±0.9, F=120.032, P=0.000; right AC 26.7±3.4, 17.1±2.9, 14.9±1.3, F=64.587, P=0.000.Compared with the left intratympanic gadolinium injection group, the intraperitoneal manganese injection group showed higher SNRs in bilateral CN and CC (P<0.05), and the left intratympanic manganese injection group showed higher SNRs in left CN, AC and bilateral CC.The SNRs of right CN, bilateral DNTB, CC and AC were significantly higher in the intraperitoneal manganese injection group than those in the left intratympanic manganese injection group (P<0.05).

CONCLUSION

MEMRI with intraperitoneal manganese injection might be the optimal method for displaying enhancement of the central auditory pathway in cats receiving auditory stimulation.

Association Between Smoking and p53 Mutation in Oesophageal Squamous Cell Carcinoma: A Meta-analysis

AIMS

Several studies have evaluated the association between smoking and p53 mutation in oesophageal squamous cell carcinoma (ESCC), but the conclusions are inconsistent. The aim of the present study was to carry out a meta-analysis evaluating the relationship between smoking and p53 mutation in patients with ESCC.

MATERIALS AND METHODS

Eligible studies were identified through searches in PubMed and EMBASE. The odds ratio with 95% confidence interval was used to assess the association. In total, 20 studies were identified that met the selection criteria; these studies were analysed using STATA 12.0 software.

RESULTS

The 20 studies identified comprised 1524 ESCC patients, of whom 72.97% were smokers and 27.03% were non-smokers. The pooled odds ratio of p53 mutation in ESCC for any cigarette smoking versus no smoking was 1.28 (95% confidence interval=0.88-1.88). The estimated odds ratios were 1.06 (95% confidence interval=0.56-2.00, based on five studies, 129 light smokers and 70 non-smokers) for light smoking and 2.01 (95% confidence interval=1.12-3.60, based on five studies, 223 heavy smokers and 73 non-smokers) for heavy smoking.

CONCLUSION

The results of our meta-analysis indicate an overall positive relationship between heavy smoking and p53 mutation in ESCC. Heavy smokers with ESCC have a higher risk for p53 mutation than non-smokers. Large-scale clinical studies are still needed to draw a more precise conclusion.

Tunable catalytic reactivity of small palladium clusters supported on graphene: a first-principles study

The catalytic reactivity is controlled by the binding strength between the catalyst surface and reaction intermediates.

Breed distribution of SOD1 alleles previously associated with canine degenerative myelopathy

Background

Previous reports associated 2 mutant SOD1 alleles (SOD1:c.118A and SOD1:c.52T) with degenerative myelopathy in 6 canine breeds. The distribution of these alleles in other breeds has not been reported.

Objective

To describe the distribution of SOD1:c.118A and SOD1:c.52T in 222 breeds.

Animals

DNA from 33,747 dogs was genotyped at SOD1:c.118,SOD1:c.52, or both. Spinal cord sections from 249 of these dogs were examined.

Methods

Retrospective analysis of 35,359 previously determined genotypes at SOD1:c.118G>A or SOD1:c.52A>T and prospective survey to update the clinical status of a subset of dogs from which samples were obtained with a relatively low ascertainment bias.

Results

The SOD1:c.118A allele was found in cross‐bred dogs and in 124 different canine breeds whereas the SOD1:c.52T allele was only found in Bernese Mountain Dogs. Most of the dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A homozygotes, but 8 dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A/G heterozygotes and had no other sequence variants in their SOD1 amino acid coding regions. The updated clinical conditions of dogs from which samples were obtained with a relatively low ascertainment bias suggest that SOD1:c.118A homozygotes are at a much higher risk of developing degenerative myelopathy than are SOD1:c.118A/G heterozygotes.

Conclusions and Clinical Importance

We conclude that the SOD1:c.118A allele is widespread and common among privately owned dogs whereas the SOD1:c.52T allele is rare and appears to be limited to Bernese Mountain Dogs. We also conclude that breeding to avoid the production of SOD1:c.118A homozygotes is a rational strategy.

Magnetism and magnetic structures of PrMn2Ge2-xSix

The structural and magnetic properties of seven PrMn2Ge2-xSix compounds with Si concentrations in the range x = 0.0-2.0 have been investigated by x-ray diffraction, magnetic (5-350 K), differential scanning calorimetry (300-500 K) and neutron diffraction (3-480 K) measurements. Replacement of Ge by Si leads to a contraction of the unit cell and significant modifications to the magnetic states--a crossover from ferromagnetism at room temperature for Ge-rich compounds to antiferromagnetism for Si-rich compounds. The compositional dependence of the room temperature lattice parameters exhibits non-linear behaviour around x = 1.2, reflecting the presence of magnetovolume effects. Re-entrant ferromagnetism has been observed in both PrMn2Ge1.0Si1.0 and PrMn2Ge0.8Si1.2 compounds with co-existence of canted ferromagnetism and canted antiferromagnetism detected, with both compounds exhibiting a larger unit cell volume in the canted Fmc state than in the canted AFmc. Combined with earlier studies of this system, the magnetic phase diagram has been constructed over the full range of PrMn2Ge2-xSix compositions (x = 0.0-2.0) and over the temperature range of interest (T = 3-480 K). In common with other systems in the RMn2X2 series, the overall magnetic behaviour of PrMn2Ge2-xSix compounds is governed by the strong dependence of the magnetic couplings on the Mn-Mn spacing within the ab-plane. Both total manganese moment µ(Mn)(tot) and in-plane manganese moment µ(Mn)(ab) at 5 K are found to decrease with increasing Si content, which can be ascribed to the reduction of Mn-Mn separation distance and stronger Si-Mn hybridization compared with Ge-Mn hybridization. Pr site ferromagnetic ordering occurs for x < 1.6 below T(Pr)(C).

Characterization of Neuronal Ceroid-Lipofuscinosis in 3 Cats

Three young domestic shorthair cats were presented for necropsy with similar histories of slowly progressive visual dysfunction and neurologic deficits. Macroscopic examination of each cat revealed cerebral and cerebellar atrophy, dilated lateral ventricles, and slight brown discoloration of the gray matter. Histologically, there was bilateral loss of neurons within the limbic, motor, somatosensory, visual, and, to a lesser extent, vestibular systems with extensive astrogliosis in the affected regions of all 3 cases. Many remaining neurons and glial cells throughout the entire central nervous system were distended by pale yellow to eosinophilic, autofluorescent cytoplasmic inclusions with ultrastructural appearances typical of neuronal ceroid-lipofuscinoses (NCLs). Differences in clinical presentation and neurological lesions suggest that the 3 cats may have had different variants of NCL. Molecular genetic characterization in the 1 cat from which DNA was available did not reveal any plausible disease-causing mutations of the CLN1 ( PPT1), CLN3, CLN5, CLN8, and CLN10 ( CTSD) genes. Further investigations will be required to identify the mutations responsible for NCLs in cats.